HomeMy WebLinkAbout17182-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 217487 Date NOVEMBER 4, 1988
THIS CERTIFIES that the building ALTERATION & ADDITION
Location of Property 165 WILSON RD. CUTCHOGUE
House No. Street Hamlet
County Tax Map No. 1000 Section 103 Block 09 Lot 07
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 27, 1988 .pursuant to which
Building Permit No.17182Z dated JULY 1, 1988
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is ALTERATION AND CONSTRUCTION OF DECK ADDITION.
The certificate is issued to TOM & GEORGE & ALEX SCOURTSIS
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED NIA
~~,1,
Building Inspector
Rev. 1/81
Fosat xo. s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON 7HE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N fl ~ 1.718 2 Z Dote ~ 19 p 8
Permission is hereby granted ta:
.
-y-
at Premises located at ..L.l..s.,...... W ~4~ ................~.~.~A.~:~..................................
Caunty Tax Map No. 1000 Section Block .....4°?.eJ.......... Lot No...~.a
pursuant to application dated .....~A.tertia......~-1 19.~.~., and approved by the
~ Building Inspector.
Fee
Budding Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11977
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~s....~ to the Building Inspec-
torwith the following; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natural or topographic features.
- 2. Final approval of Health pept. of water supply and sewerage disposal-IS-9 form or equal.
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, acertificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00
1. Certificate of occupancy New Dwelling $25.00, Accessory 10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $100.00
3. Copy of certificate of occupancy $ 5 .00 , over 5 years $ 10.00
4.Vacant Land C.O. $ 20.00
S.Uodated C.O. $ 50.00 Date I.:
New Construction.,,,,,01dorPre-existing Buildingpp,........... Vacant Land
Location of Property s W ,n~ S o h Y` d C Ui C v 2
House No. q Streat Ham/et
Owner or Owners of Property OM.f',~eut-~e f J7~2X Jccot,t.~;~sl1
County Tax Map No. 1000 Section ~ Q Block ~ , Lot ~ .
Subdivision .................................Filed Map No. ..........Lot No. .
Permit No.4.~, Date of Permit ~a~y.(t19YXApplicant
Health Dept. Approval ................../......Labor Dept. Approval .
Underwriters Approval . . . . . .planning Board Approval , .
Request for Temporary Certificate . .........Final Certificate , . , .
Fee Submitted $
Construction on above described building an~,e~r„mit m is all applicable codes and regulations.
Applicant./.~T!'.:..~~
Ra~. ,e-,e.~e ~ , 3~ r as
~}~1 L ~lo lG u ~/Lso1l (1~~~~~
~'U7'~No czr~ar G.Q•?.~
„~ruim;,-, ; TEL. 7G5.1807
y ~~~FFOL/`
~v r.~; ~ri~~~~rl ~t~~ soux'~~t,t~
fir, , - ~,t ((~~~,~1
r /~r:~L1,:~fAn,~l~j~ OfS~ICi~ OF ISUILUINC: INSPEC"1'C)R
!r ~ 'yr r ~t1'}(`'y'~77,, x,~ I'.O. [30`Y 728
~j,}! ~y al 7'OtVN HALL
' c~C' SOU'I'!{O{.D N.Y.11971
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~~~1 d~~E ~~U~
zz-tuN o,~.U.~ti l l , l 9~s~
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~c.r.~ ~r~un~o~r~,
7'n Whom 't'his; hS<1y Concern,
l;c nrn unable r.o complete your Certificate
nL~ocr~np,rncy },~.~.;ir,.;c of the following reasons.
/v'/ J1n ,,S,pli.caLion t:or. Ccrtific<~te of occupancy
i:: ant- on fil.n. .
/ / tlnclr;r.~.:r it:cr:s Certificate on file.
'1 f;r~ c:Yr<~c:); i:s r~ • -~cl/ttot on file.) .~~.d~
/ / t:r; t;c~alt.lr De}~t. Approval on file.
}t~~ .`innl inspcct.iorr ha;, been made.
S'lc•~:;c cunLacl. cur office on this, matter.
Thank yrn; f,or your cooperation.
;l~cilc;in~ I'rrmi.t II ~ ~ Z
I:U 11r7]Ilrt UUjJt.
hhh/-/ S'lumbcr :;al dar: Cer L•.if icate nn file.
( all hermi.C:; i.nvolvinq plumbing being
is^uccl ,zft:rr Aor:il 1,1904
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` 2. ROUGH - FRAM9NG ;'v r'~ P,)A/'r -hpv
INSULATION
OCCUPANCY dR a. FINAL - CONSTRUt~TION ttflilST
US~'S BE COMPLETE FOR C.O.
UNLAWFU[, ALL CONSTRUCTION SHALL MEET
VV9TH0(~~' CER'TIFIGgTE THE REOUIREMENT3 OF THE N.V,
OCCUPANCY STATE CONSTRUCTION & ENERGY
COQES. NOT RESI'ONSI81•E FOR
DESIGN OR CONSTRUCTION ERRORS
i~ 1G ~e
j~`;''~_4~•~.,s~,.i1 t~~ BOARD OF HEALTH ~ ~ .
;i'1t{ 3 SETS OF PLANS . , .
' t i~ FORM NO. 7 SURVEY . ,
~4V TOWN OF SOUTHOLD CHECK .:~.~~~-a~~;~
BUILDING DEPARTMENT SEPTIC rORM , ,
gt,pG. DEPT. TOWN HALL
TO~If~UFSOUTHOt.D vOUTHOLD, N.Y. 11971 NOTIFY ~y ~7("~'
TEL.: 765.1802 CALL `"~d" 7 C~
Examined 1 . ~ 19 MAIL T 0
1 JJ~` X v2.7 i~- '
Approved 6,n.Qa,t, 19)}?~. Permit No. ~ .t ~ _ / s~C~U~~f'~C''-~~°/~~~v/C
Disapproved a(c , , , , . , , , , , (Jur{/Gy ~~"'"Y~
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ~ 7........, 15 ~i'r~'
INSTRUCTIONS
a. Tlris application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan shoving ]ocation of lot and of buildings on premises, relationship to adjoining premises or public streets
or areas, and giving a detailed description of layout of property must 6e drawn on the diagram which is part of this appli-
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Re,ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspection,
.
(Signature of applicant, or name, tf a corporation)
,'6',U~ 2 72 rcHd GUE .
' (Mailing address of applicant) Y 3J'.
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
......p..rill.~?E=~.......~/
Name of owner of premises . f~~G k/~. ~ep~`~'~~.. , TO y7 U/' Tel/J`
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No... , ..CJ.L?. ~~p~.......... .
Plumber's License No . .
Electrician's License No. .
Other Trade's License No.
1. Location of land on which proposed work will be done. , .~t? , , , , , '
. . . . . . . . . .
House Number Street Hamlet
County Tax Map No. 1000 Section 1.~3.......... Block ....G~ Lot , .
Subdivision Filed Map No. Lot.............
(Name) 1i . .
State existing use and occupancy of premises and intended use and occupancy of proposed construction: '
a. Existing use and occupancy ....._~.~r.~!^~~ ,~t.etvy.~', , , ,
b. Intended use and occupancy ^•~~.Q'H-. • ~G/~ '
i
I
3. Nature of work check which a lil
Removacable): New E3uilding , Addition teration 8o,f' , ,
Repair pp
• • • Il • • • • • • • Demolition
C a't}„Z? ~~K..... .
4. Estimated Cost , 0~~ (Description)
~.....t..~ Fee..,,.. ....-t
(to be pard on filing this a {ilicati'on)
a, nurnber of dwellin un
5. If dtvcllin~ g fits , . , , (~!fL; , , , , , , Number of dwelling units on each floor .
If g;trage, number of cars , .
6. If business, commercial or mixed o,'ecupancy, specify nature and extent of eacJt type of use , , , . . . . . . . .
7, Dimensions of existing stru Numbelf any: Front . , , , ,
Heil;ltt Rear Depth....,........,.
p rafStorics
rmensrons of same structure with
~ alterations or additions: Front ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ • '
Dc th Rear
IIeight ......................Number of Stories .
8. DHcm~ ~sions of entire new constnre,'tion: Front . Rear ...1.~/>c,2, 2, jCCk Depth ,
f= , Number of Stories . • " " " • •
9. Size of lot: Front . ' Rear . • • ......Depth .
10. Date of Purchase , ,/~QR(~ (~,c~ , . , • , . , , ,Name of Former Owner ;~~t/L SH C! J/,tTZ ~ ~ ~ ~ ~ ~ ~ ~ ~ '
1 1. Zone or use district in which premises are situated . , .~ES!?~GsI1~C!(1;L„ , ~ ~ • ~ ' ' ' ' ' ' ' ' • '
2. Does proposed construction violate any zoning law, ordinance or regulation: .
13. Will lot be regraded , ; , , , , , , , , , , • , , , , , , , Will excess fill be removed from premises: Yes
14. Name of Owner of remises . LE
P ~ ~1 f. ;Scp,vzrf}f, .Address ,/•G,T..tr/IG;fQN .~1), ..Phone No. Z.~~ ~Q.~Q.
Narne of Architect . . . . .Address , .Phone Na. .
* arneo Contractor......••••¢d w3 thin ~
If es Southold Town ,.•...•••.•••~~'Address Phone No......
IS.Is th>,s ro ert locat X00 feet of a tidal wetland. *YLrS..., 0
y ,Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all U;uildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or eornor lot.
- ,
i
STATE OF NE1V YORK,
COUNTY OF...,S~.FF ~Lk~dc$•S
• ~ ~ ~ •Y~'LD~~ .~`f~ • • • • • • • being duly sworn, deposes and says that he is the applicant
(Name of indivrdual srgnuhg contract)
above named.
He is the .......U',1t!N,L;1~...... ~ .
~ (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly- authorized to perform or !rave performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the mannerset forth in the application filed therewith.
Sworn to before me this j
........7uN,L-;~/.,.,...,..dayof}'~27// .1~74~~
Notary Public, ,M~~K.~.. ,A~/., .A'-1k; ,G14,° . , , . , County ~~,g'~c, ,4~2-~W'~ ~
0uu / i ~ r
HELENgK OE VOE ~ .
~ No. 4707878 Sulrotk ~nl~, (Si;nature of applicant)
pines Mir~Ch
30,1>) • . .
I 1
R~A~ ,
, i,s.o~
- WILSON s.~s°iaSOW.
ii5.oo r_
' N. 19 °13150 E y
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it n re now °r Mor9on ~
o.s• , , ~ ponold OBrown
now °r P
oBergen = o r'// / Z i' g54 5Q. ft. ° Sue ~
Areo
garboro : o ~M'
CND
IINIIN FENCE
P1• I I5~ o ~
A
SPLIt RAIL
._r--:~~~~ a_. FENCE _ _ -
r
now or fO ~hioer
~ e rfn~de
now or fa~Muriel E.Wreden
Robert i?
I
3
SURVEY FOR
GEORGE SCOURTSIS ~ TOM SCOURTSIS a ALEXIS SCOURTSIS
AT CUTCNOGUE DATE APR.22, 1988
TOWN OF SOUTHOLD Y~ scALE: I"=5o'
SUFFOLK COUNTY, NEW YORK N0. 88-0399 r
A UNAUTHORIZED ALTERATION OR ADDITION TO THIS GUGR g ®FT
SURVEY IS A VIOLATION OF SEC 71ON 7209 OF THE
NEW YORK STATE EDUCATION LAW
M COPIES OF THIS SURVEY NOT BEARING THE LAND O. f~j Q9 '
SUR VE YOR~S INKED SEAL OR EMBOSSED SEAL SHALL AL SCO(1R 'r ~ •
NOT BE CONSIDERED TO BE A VALID TRUE COPY y( N O ~ QR GAGE CORP.
M GUARANTEES INDICATED HEREON SMALL RUN ONLY TO T~
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT rHE PERSON FOR WHOM THE SURVEY IS PREPARED,
AND ON HIS BEHALF TO THE TITLE COM PANY, GOVE RN- '
if NEAREST WATER MAIN_MI!lF BOURSE OF WATER~PRIVATE~[PUBLIC~ MENT4L AGENCY AND LENDING INSTITUTION LISTED
iF BUFF CO. TA%MAP DIS T.noo SECTION log BLOCK ~_LOT 1_ HE REON, AND TO THE ASSIGNEES OF THE LENDING
MTHERE ARE NO DWELLIN09 WITHIN 100 FEET OF TMI9 PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE
OTHER THAN TH09E SHOWN HEREON. TOWI/EN6TIONAL INSTITUTIONS OR SUBSEQUENT ~Q 4589
iF THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE µDISTANCES SHOWN HEREON FROM PROPERTY LINES ~4'
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUN TY DEPARTMENT TO Ez15 TING STRUCTURES ARE FOR A SPECKIC 0 ~
OF HEALTH SERVICES PURPOSE PND ARE NOT TO BE USED TO ESTABLISH AND S
APPLICANT PROPERTY LINES OR FOR TILE ERECTION Of FENCES. '
ADDRESS
- TELL- YOUNG Q YOUNG RIOVERHEADNNEW YORK E
MOTE
• • MONUMENT ~ ALDEN W YOUNG,PROFESSIONAL ENGINEER
AND LAND SURVEYOR NYS.LICENSE N0,12B45 '
o ~ STAKE
HOWARD W YOUNG, LAND SURVEYOR
1F THE LOCATKm of weulw)sEPTIC TANK(9T)6 CESSPOOLS (CP)9MOwN HEREON NYS. LICENSE NO 45893 '
APE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS